tbuckley/cabot-search huggingface dataset:
Nursing strategies to improve alert closure for remote symptom monitoring.
Authors: Megan Patterson, Nicole E. Caston, Jeffrey Franks, D'Ambra Dent, Stacey A. Ingram, Keyonsis Hildreth, Fallon Lalor, Andres Azuero, Jennifer Young Pierce, Chelsea L. McGowen, Courtney J. Andrews, Chao-Hui Huang, James Nicholas Dionne-Odom, Bradford E. Jackson, Bryan J Weiner, Ethan Basch, Angela M. Stover, Doris Howell, Gabrielle Betty Rocque
Journal: Journal of Clinical Oncology (2022)

421 Background: For successful remote symptom monitoring using patient-reported outcomes, nurses should respond to alerts in a timely fashion. Where clinical trials utilized research staff for alert management, the shift to standard-of-care delivery necessitates that this responsibility be added as a task to an already strained nursing workforce. Little is known about strategies to engage nurses to improve timeliness of alert management. Methods: In this quality improvement initiative, we aimed to improve timeliness of alert closures generated by moderate or severe symptoms within a remote symptom monitoring program. Optimal closure was defined as &lt; 48 hours, which was consistent with institutional requirements for response to patient phone calls. A continuous quality improvement approach, with multiple Plan Do Study Act (PDSA) cycles was conducted. Data was captured from the electronic medical record and PRO platform (Carevive). Descriptive statistics included frequencies and percentages. The proportion of alerts closed each month &lt; 48 hours, 48-72 hours, 3-7 days, and &gt; 7 days were reported overall and by disease team (i.e., major cancer types). Surveys not closed were considered &gt; 7 days. The timing of strategies to improve nursing engagement were documented and evaluated for impact on alert closure. Results: From June 1, 2021-May 31, 2022, 1121 moderate or severe alerts were generated from 234 patients. Disease teams had variable remote symptom monitoring start dates: breast, leukemia, and limited gynecologic (prior to 6/2021); myeloma and gastrointestinal (7/2021); genitourinary (10/2021); head and neck (12/2021); melanoma (2/2022); and Lymphoma (4/2022). In 6/2021, the overall alert closure at &lt; 48 hours, 48-72 hours, 3-7 days, and &gt; 7 days was 57%, 4%, 14%, and 25% respectively (n = 28). To improve alert closures, several key strategies were deployed to improve alert closure times including disease-specific reporting and meetings with nursing leadership (10/2021); identification of a nurse champion, creation of “cheat sheets” to remind nurses how to close alerts, and individualized calls with nurses with open alerts (1/2022), and inclusions of requirement to close alerts in nursing newsletters (2/2022). Overall, alert closure less than 48 hours improved to 61% by 12/2021 (n = 97) and to 69% by 5/2022 (n = 167). Disease group alert closure varied, with higher closure more commonly in teams with greater duration of use, such as breast cancer team with an alert closure of 85% &lt; 48 hours in May 2022. Conclusions: Key nursing engagement strategies improve alert closure for remote symptom monitoring programs implemented in real-world settings.
Automated malnutrition screening in a multisite cancer center.
Authors: Kunal C. Kadakia, Michele Szafranski, Patrick L. Meadors, Aynur Aktas, Declan Walsh
Journal: Journal of Clinical Oncology (2022)

415 Background: Malnutrition (MN) negatively impacts patients’ tolerance to anti-cancer therapies and clinical outcomes. Registered dietitian nutritionists (RDNs) are integral to establishing personalized nutritional plans but are a limited resource at cancer centers. The optimal method for operationalizing MN screening and assessment by an RDN is not established. The present study describes the experience of MN screening and automated RDN assessment at Atrium Health’s Levine Cancer Institute. Methods: MN screening using the Malnutrition Screening Tool (MST) was added to our institution’s electronic distress screening process in May 2017. Automated email alerts to review electronic medical records (EMR) of those with high risk for MN (MST ≥3 of 5; H-MST) before formal RDN evaluation were added in October 2017. RDN reviewed the EMR to identify malnutrition based on internationally accepted guidelines. Here we describe our experience over a 8-month period from May 2019 through December 2019. Results: Among 4009 unique patients who completed the MST, 2953 (74%) had a score of 0-2, 1056 (26%) had H-MST with scores of 3, 4, and 5 in 514 (13%), 349 (9%), and 193 (5%), respectively. Among H-MST screens, automated RDN evaluation occurred in 512 (48%). EMR review by the RDN revealed that 242 (47%) met MN criteria for formal RDN evaluation. The reasons for exclusion from formal RDN evaluation included no weight loss documented (114, 22%), non-malignant condition (107, 21%), and others (49,10%) (deceased, hospitalized, no reason listed, or enrolled in hospice). Of those who were planned for formal RDN evaluation, 97 (40%) underwent phone evaluation, 75 (31%) had already established care with an RDN, 41 (17%) underwent in-person evaluation, and 29 (12%) were unable to be contacted. Conclusions: Using electronic screening, 26% of cancer patients are at high risk for MN at diagnosis. Automated RDN review of H-MST screened patients can improve the referral process and optimize limited RDN availability. The current process allows formal RDN evaluations on those with the greatest MN risk. Malnutrition screening protocols focused on the highest risk cancers might further improve this process. More research is needed to optimize RDN staffing and referral practices.
Impact of Breast Cancer Pathways on ER utilization and hospitalization.
Authors: Jane Leu, Lisa Doelger, Wade Bannister, Erica Stevens, Timothy Foley, William A. Flood
Journal: Journal of Clinical Oncology (2022)

423 Background:Optum’s Cancer Guidance Program promotes value-based care by ensuring that treatments follow evidence-based guidelines and encouraging the use of cancer therapy pathways. Criteria for selection of treatments for pathways include efficacy, toxicity and cost so Pathways could be expected to decrease emergency room utilization and hospitalizations that result from adverse events of therapy. We conducted this study to evaluate the impact of Pathways adherence (on vs. off Pathways) on hospital inpatient and emergency department utilization among commercially insured members with breast cancer. Methods: This cross-sectional matched case-control study used medical claims and prior authorization data to evaluate 12 months of program experience (11/1/2019 – 10/31/2020). Individuals were included if they were 19+ years old, enrolled in the health plan, had actively treated breast cancer (breast cancer diagnosis and 1+ cancer related treatment procedure), and had a cancer drug therapy prior authorization during the study period. On Pathway cases were matched to off Pathway controls with propensity score and outcomes were measured using generalized linear models. The propensity score was estimated using demographic characteristics, cost/utilization preceding the prior authorization request, and clinical indicators (HER2 status, advanced disease, adjuvant vs neoadjuvant therapy, multiple lines of therapy, ECOG /Karnofsky, regimen emetic risk). Outcomes were measured across the member’s treatment episode from first month of active cancer treatment to 3 months after last month of active cancer treatment. Results: Compared to those who were off Pathway (n = 1,001), patients treated with a Pathways regimen (n = 1,001) had 18% lower (p-value = 0.03) all-cause inpatient admissions, 14% lower (p-value = 0.10) cancer-related inpatient admissions, 18% lower (p-value = 0.11) all-cause emergency department visits, no difference in (p-value = 1.00) cancer-related inpatient bed days, 8% lower (p-value = 0.31) all-cause emergency department visits, and 1% lower (p-value = 0.92) cancer-related emergency department visits. Conclusions: Treatment with a Pathway regimen was associated with fewer all-cause and cancer-related visits to inpatient hospitalizations and fewer all-cause inpatient bed days.
Health care costs among men with metastatic castration-resistant prostate cancer (mCRPC) in the U.S. Medicare population.
Authors: Stephen J. Freedland, Matthew Davis, Andrew J. Epstein, Bhakti Arondekar, Jasmina I. Ivanova
Journal: Journal of Clinical Oncology (2022)

10 Background: Studies have reported healthcare costs before and after mCRPC diagnosis in commercially insured populations, but no information is available about costs with progression through lines of therapy after mCRPC diagnosis. This study describes healthcare costs among men with mCRPC in the US Medicare population before mCRPC diagnosis, after diagnosis, and with progression through lines of therapy. Methods: Men newly diagnosed with mCRPC were identified in Medicare fee-for-service claims during 1/1/2014–6/30/2019. Adult men were required to have a diagnosis of prostate cancer, metastasis diagnosis, castration-resistance using a published claims-based algorithm, and continuous insurance coverage for ≥1 year before and ≥6 months after index mCRPC diagnosis unless patients died. Unadjusted all-cause healthcare costs (medical and pharmacy) per patient per year (PPPY) to Medicare inflated to 2019 dollars were described for the periods before mCRPC diagnosis, after diagnosis, and from the start of first-line (1L), second-line (2L), and third-line (3L) therapy with mCRPC life-prolonging treatments to the start of subsequent therapy or end of follow up. Results: Among 14,780 men with mCRPC, median age was 75 years, and the mean Quan-Charlson Comorbidity Index was 2.1. Median follow-up after mCRPC diagnosis was 17 months. During the follow up, 3,252 men had no life-prolonging treatment, 11,528 men initiated 1L mCRPC therapy, 6,275 initiated 2L, and 2,945 initiated 3L. Mean all-cause healthcare costs PPPY were $27,468 in the year before mCRPC diagnosis, $124,379 after mCRPC diagnosis, $102,380 among men without life-prolonging treatment after mCRPC diagnosis, $148,325 from the start of 1L to subsequent therapy or end of follow up, $160,118 from the start of 2L therapy, and $165,186 from the start of 3L therapy. Conclusions: Mean healthcare costs increased over 4-fold from before to after mCRPC diagnosis and increased steadily as patients progressed from first through third lines of mCRPC therapy. These findings help quantify the economic burden of mCRPC and contextualize the economic value of treatments that delay disease progression.[Table: see text]
Decentralized and hybrid trials in oncology: Results of a global survey of clinical research executives.
Authors: Shaalan Shaalan Beg, Drew Bustos
Journal: Journal of Clinical Oncology (2022)

102 Background: Decentralized (DCT) and hybrid (Agile) clinical trials have the potential to deliver significant enhancements to trial operations by improving access to patients and providers. We conducted a survey of research executives at sponsor sites and contract research organizations (CRO) to understand trends in oncology clinical trials. Methods: The survey took place in March and April 2022 via online questionnaires. Only complete responses from senior executives who are either involved in sponsoring or managing clinical research within oncology, or who are planning to execute oncology clinical trials in future, were included. Response data were analyzed by an independent market research service and tested for significance at the 95% confidence level. Results: The questionnaires generated a “qualified” respondent sample of 85 responses. Most (60%) respondents were from biopharmaceutical sponsors, with around one-third from organizations with more than US$20 billion in revenue. The most frequent perceived challenges for oncology clinical trials execution were patient recruitment (72% of execs ranked this in their top 3); study start-up (55%); and study delays (54%). Three in four executives (73%) are planning to run either a DCT or hybrid trial for oncology in the next 12 months, up significantly from 49% in the prior 12 months. Most common cancer indications for DCT in the next 12 months are lung cancer (40%), leukemia/blood cancers (37%), and breast cancer (30%). More than half of respondents reported that they plan to include ePRO/eCOA tools (57%) and telemedicine (54%) in their oncology clinical trial designs over the next 12 months. A further 48% expect to deploy Mobile Nurses, with the same number planning to incorporate eConsent. The top three perceived benefits of using DCT tools identified in oncology trials are increased patient retention (67%); greater patient diversity (54%); and faster patient recruitment (50%). Conclusions: The survey of oncology research executives highlights the most common perceived challenges in executing clinical trials. Many of these challenges can be addressed using decentralized tools. Researchers are planning to significantly increase the adoption of DCT in the coming year. DCT adoption in oncology clinical trials Prev 12 mos Next 12 mos Traditional, Site-Based Trial 88% 65% Agile Trial (Hybrid) 43% 58% Fully Decentralized Trial 19% 40% Agile Trial OR Fully Decentralized Trial 49% 73%.
Health-related quality of life among metastatic prostate cancer survivors: Comparisons to survivors originally diagnosed with localized disease and men without a cancer history in the United States.
Authors: Zhiyuan Zheng, Kewei Shi, K. Robin Robin Yabroff
Journal: Journal of Clinical Oncology (2022)

205 Background: Maximizing health-related quality of life (HRQOL) is an important therapeutic goal for metastatic prostate cancer patients. Moreover, HRQOL measures can inform clinicians about treatment sequelae and aide decision-making. To date, few studies have comprehensively compared HRQOL between metastatic prostate cancer survivors and survivors with localized diseases and men without a cancer history. Methods: The SEER-Medicare Health Outcomes Survey (MHOS) data linkage was used to identify prostate cancer survivors and individuals without a cancer history enrolled in Medicare Advantage plans. Prostate cancer survivors (diagnosed 1988-2017) who completed the MHOS baseline survey (1998-2019) after diagnosis but &lt; 10 years post diagnosis were included, as were men without a cancer history who completed the MHOS in the same years. Survey records were clustered at person-level. 27,829 prostate cancer survivors with 42,277 survey records (metastatic n = 752 with 1040 records) and 784,305 Medicare Advantage enrollees in SEER regions without a cancer history with 1.15 million survey records were identified. Multilevel linear regressions were used to compare HRQOL outcomes, i.e. The Veterans RAND 12 Item Health Survey (VR-12 scores), between metastatic survivors and other survivors, and men without a cancer history. The VR-12 includes 8 health domains: general health, physical functioning, role limitations due to physical and emotional problems, bodily pain, energy-fatigue, social functioning and mental health. All analyses adjusted for age at survey, stage, comorbid conditions, body mass index, race/ethnicity, marital status, socioeconomic status, SEER region, and survey era. Results: Compared to men without a cancer history, prostate cancer survivors were older, had fewer comorbid conditions, were more likely to racial/ethnic minorities, married, and higher socioeconomic status. Compared to men without a cancer history, metastatic prostate cancer survivors were most likely to report worse general health (T-score difference: -6.26, 95% confidence internal [95CI]: -7.14 to -5.38; p &lt;.001), and physical (T-score difference: -4.33, 95CI: -5.18 to -3.48; p &lt;.001) and mental component summary (T-score difference: -2.64, 95CI: -3.40 to -1.88; p &lt;.001), followed by survivors with early stage diseases in adjusted analyses. Results were similar for other HRQOL VR-12 measures. Conclusions: Metastatic prostate cancer survivors experience significantly worse HRQOL than men diagnosed with early-stage disease and men without a cancer history across all domains. Our findings suggest a need for better symptom management and palliative care for men diagnosed with metastatic prostate cancer.
Patient-reported satisfaction with care and care coordination: Results from an online survey conducted in Manitoba, Canada during the COVID-19 pandemic.
Authors: Maclean Harvey Thiessen, Kathleen Decker, Jason Park, Andrea Soriano
Journal: Journal of Clinical Oncology (2022)

258 Background: In Manitoba, Canada, changes to cancer care delivery implemented in response to the COVID19 pandemic included, but were not limited to, restrictions on informal caregiver accompaniment for ambulatory care appointments and implementation of physician care administered over the telephone. These changes were predicted to negatively impact the patient experience, specifically patient satisfaction with care and perceived care coordination. To assess this, a survey of patients on active treatment was conducted. Methods: After ethics approval, a SurveyMonkey survey was conducted of cancer patients receiving radiation and IV treatment at one of the 24 cancer treatment sites across Manitoba. The survey collected demographics, disease characteristics, functional status and responses to validated questionnaires addressing satisfaction with care (PSCC), and care coordination (CCQP, including communication (CCQP comm ) and navigation (CCQP nav ) subscales). Mean differences of PSCC and CCQP scores (including subscales) were compared using t-test for dichotomous patient characteristics and ANOVA followed by post-hoc pairwise t-tests for non-dichotomous categorical patient characteristics with statistically significant ANOVA results. Results: Between July 2020 and February 2022, 203 responses were collected. The 154 respondents with complete responses for either PSCC, CCQP or both were included in this analysis. Median age of respondents was 64.6 (SD = 11.7). Sex was balanced (male = 47%, female = 52.3%, other/prefer not to say = 0.7%). Breast (26.1%), hematological (13.7%), and prostate (13.1%) cancers were the most common. PSCC and CCQP scores did not differ by marital status, treatment site, disease type, or treatment intent (i.e., curative versus non-curative). Individuals with lower functional status (i.e., ECOG &gt; 1) were identified to have lower mean scores for CCQP and CCQP comm . Patients &lt; 59 years had lower mean PSCC scores compared to those 59 – 69, and 70+. See Table for comparison of CCPQ and PSCC scores by age and functional status. Conclusions: Young patients and those with decreased functional status were identified to have statistically significant lower mean scores for PREMs reflecting satisfaction and coordination of care. Further work to identify meaningful strategies to improve the patient experience for these two patient groups is needed.[Table: see text]
Development of an mHealth app integrating pain-cognitive behavioral therapy and opioid support for patients with advanced cancer (STAMP+CBT).
Authors: Desiree Rachel Azizoddin, Kris-Ann S. Anderson, Ashton Riley Baltazar, Meghan R Beck, James A. Tulsky, Robert R. Edwards, Michael Businelle, Andrea Catherine Enzinger
Journal: Journal of Clinical Oncology (2022)

418 Background: Pain affects 40-90% of patients with advanced cancer. Supplementing pharmacologic therapy with behavioral skills may improve pain outcomes. We sought to evaluate patients’ perspectives of a pain-cognitive behavioral therapy (CBT) mobile health intervention for cancer pain. Methods: We recruited patients from the Dana-Faber Cancer Institute outpatient palliative care clinic to review the pain-CBT mHealth intervention. Eligible patients were &gt;21 years old, had an incurable solid malignancy, chronic pain related to cancer, and were using opioids for cancer. We excluded hospitalized patients and those with pain from a recent surgery, dementia/delirium, or an opioid use disorder. In individual, qualitative interviews patients reviewed pain-CBT content modified for advanced cancer and mHealth delivery, and provided feedback on the relevance of the content in the context of their own pain. Results: Patients (n = 14) reviewed pain-CBT app content and wireframes. Most rated the content and user interface as highly usable, informative, aesthetically pleasing, convenient, and relevant to their experiences. Suggested improvement included revising technical content to increase clarity/reduce literacy, shortening length of texts, and including additional tracking for daily opioid use. Six subthemes regarding patients’ current pain management approaches were identified. Individuals endorsed using physical coping skills including engaging in physical activity and at times struggling to recognize physical limits. Many endorsed utilizing psychological coping such as accepting their pain, reframing thoughts about pain, and using distraction or relaxation to cope. Social support was relevant to coping for almost all patients, and many described COVID-19 distancing guidelines as disruptive. Patients endorsed complex relationships with opioids including guilt related to use or difficulty understanding prescription instructions. Most patients emphasized the relationship between sleep, stress, and pain as central to their pain management, and that they wished their clinicians reviewed the relationship between pain and stress earlier. Conclusions: MHealth delivery was viewed as an attractive method to both integrate and deliver behavioral pain management skills with opioid support to alleviate cancer pain. A future pilot study will evaluate the app’s feasibility and acceptability in patients with advanced cancer.
The association between medical cannabis and prescription opioid medication use in patients with early-stage cancer: A population-based study.
Authors: Safiya Karim, Dylan E. O'Sullivan, Darren R Brenner, Winson Y. Cheung
Journal: Journal of Clinical Oncology (2022)

228 Background: Medical cannabis (MC) and prescription opioid medication (POM) use is common among cancer patients. There is conflicting evidence on the association of cannabis with POM as to whether cannabis can help decrease/ cease opioid use. In this population-based study, we examine the association between MC authorization and cessation or reduction in POM use among patients with early stage cancer. Methods: This is a retrospective, population-based study of patients with early stage (stage I-III) cancer diagnosed between January 1, 2014 and December 31, 2018 in the province of Alberta, Canada. Cases were identified from the Alberta Cancer Registry (ACR) and linked to the provincial pharmacy information network (PIN) and the database from the College of Physician and Surgeons of Alberta (CPSA). Patient and treatment characteristic were used to identify a comparable non-MC group with prior POM use via probabilistic modelling. Descriptive statistics were used to describe differences between patients with and without a MC authorization. Modified Poisson regression was used to compare the likelihood of opioid cessation and reduction among groups. Results: We identified 8,801 patients of whom 326 (3.7%) had a MC authorization. Patients with a MC authorization were younger, had higher stage disease, underwent radiation and/or systemic therapy and had a higher total oral morphine equivalent (OME) use at baseline (p &lt; 0.01). Patients with a MC authorization were less likely to cease POM at 9-12 months post MC authorization (RR 0.63, 95% CI 0.57-0.70), and less likely to reduce their POM dose by 25% (RR 0.79, 95% CI 0.74-0.85) and 50%. (RR 0.73, 95% CI 0.67-0.79). Conclusions: Patients with early stage, non-metastatic cancer with a MC authorization have higher rates of baseline POM use and are less likely to cease or reduce their POM use up to 1 year after MC authorization. Further study is required to understand the harms of concomitant MC and POM use and the impact on survivorship care.